Another Case - Dr. Banaga
By Dr. Joel Hochman, M.D.
NFTP
Here we go again. Let's guess: Dr. Banaga was the only doctor in the area who would prescribe opioids, including OxyContin, to chronic pain patients. He ended up with 500 CPP whom he saw once a month. To control their pain adequately, on the average they required 200 -300 mg of opioid a day. He was seeing 15 to 20 patients a day, for each of whom he prescribed two strengths of a long-acting opiate, such as OxyContin, and a breakthrough medication. That meant, he was writing 10 prescriptions for OxyContin every day, or 200 a month. In 20 months he might have written as many as 4000 OxyContin prescriptions. He estimated 2800.
Let us next assume that of his 500 patients, 5 were willing to risk their doctor and their own pain management, for the quick money that OxyContin can bring. If Dr. Banaga wrote them prescriptions for 180 80mg OxyC per month (2,every eight hours) and 90 40 mg per month (1 every eight hours) that could generate $12,600 + $3600 in drug money on the black market. If each patient was willing to suffer a 6-7 pain level, instead of a 3-4 pain level, by selling half their prescriptions, that would each still get $8,1000 per month.
This would create a diversion market of 450 80 mg OxyContin and 225 40 mg tablets every month. In a small town this would create a "flood" of OxyContin. If every month 3 people overdosed from ground up and snorted or injected medication, that would total 36 people a year. In a rural town this would constitute an epidemic.
So, do we put the other 495 legitimate and law-abiding patients into the commode, by destroying their doctor? And if we do, what doctor will want to take his place with those 495 patients? Get the picture? Do we really accept, as logical, the argument that Dr. Banaga is a stupid idiot who blythely and carelessly handed out OxyContin prescriptions indiscriminately to make some quick cash for two years, until the local constabulary decided he was a drug dealer?
Or is it more rational and logical to assume that local law enforcement, seeking to find a demon behind the epidemic of local overdoses, decided that it must be the doc? They didn't know or care about all the other patients who would have been horrified by the suggestion that they sell drugs illegally.
Read the story. See what you think.
Dr.Hochman
NFTP
Doctor charged with OxyContin scheme
JAHI HARVEY and KATE MOORE , Morning Journal Writers
08/08/2002
LORAIN -- Pharmacists in Huron County grew suspicious about Dr. Rogelio Banaga after noticing that people from as far away as 55 miles were coming to fill OxyContin prescriptions from his offices in Lorain and Strongsville.
"You hate to turn down a $1,000 prescription" said Rite Aid pharmacist Bill Leaser who worked at the Norwalk store. "But it was getting to the point where we would fill a prescription, then someone else would come in right after them with the same prescription. We knew they were coming from the same place, and we knew something was wrong."
The pharmacists were not yet aware of the OxyContin craze in which the highly addictive painkiller pills -- used primarily for cancer patients -- are crushed and snorted for a high similar to heroin.
"Pharmacists in Willard were asking us, 'Who is this Dr. Banaga?' and 'What is this OxyContin?' But the prescriptions were valid," said Capt. Robert McLaughlin of the Huron County Sheriff's Department.
The pills were selling on the streets of Huron County at one dollar per milligram, said McLaughlin, and demand for OxyContin got so high that some pharmacies quit stocking it.
The complaints by the pharmacists prompted the Lorain County Drug Task Force, the Willard Police Department and the Huron County Sheriff's Department to launch a two-year undercover investigation that eventually resulted in a 44-count indictment against Banaga in September 2001. Thirty- three other people were arrested. Twenty of those arrested were alleged "doctor shoppers" who were accused of going to several doctors and faking illnesses to get prescriptions written. Another 13 were arrested on drug trafficking charges.
Banaga, 56, faces one count of engaging in a pattern of corrupt activity, 14 counts of trafficking in drugs, 14 counts of corrupting another with drugs and 14 counts of illegal processing of drug documents.
He was arrested outside his Lorain office on Sept. 21, 2001. Lorain County Sheriff's detective Greg Mehling said they arrested him in the parking lot after the office closed to avoid embarrassing legitimate patients.
One count of carrying a concealed weapon was later added because officers said they found a loaded .25 caliber semi-automatic pistol on Banaga when he was arrested. He was released on $100,000 bond the same day. Banaga's patient records, spreadsheets, office visit invoices, and tabulations of prescriptions or drugs sold were seized from that office and another office in Strongsville. He pleaded not guilty to all 44 felony counts. A trial date has not been set, but Banaga's defense attorneys said it will probably start in late fall. Banaga has chosen not to practice medicine pending his trial.
Lorain County Sheriff's detectives said they started looking at Banaga in February 1999. "We found it unusual that a number of people came from 55 miles away to get prescriptions filled," said Mehling. "They'd have to pass eight or nine hospitals with hundreds of doctors just to go to Banaga."
Almost a year before Banaga's arrest, Mehling and another detective taped an interview with him in his office in which Mehling said Banaga admitted a number of damning things the prosecution plans to use as evidence when trial begins. Banaga said on tape that day that he wrote roughly 2,800 prescriptions for OxyContin in a 20-month time period, according to a transcript filed with court documents.
The doctor admitted he continued to write prescriptions for patients who he knew were being watched by police for using multiple doctors to get prescriptions, according to the transcript. Banaga told them that about 40 percent of his patients paid cash, according to the transcript, and he added that he thought as many as 30 or 40 percent of his patients were addicted to painkillers, yet referred none for help. Banaga told them that several young people who worked for him in the past had received prescriptions for OxyContin, according to the transcript. He also confirmed there were at least 10 people from Willard who were allegedly from the same family and were receiving OxyContin prescriptions from him, according to the transcript.
Banaga's defense has moved that the tape of the Nov. 3, 2000, interview be suppressed, arguing that Banaga's rights weren't thoroughly explained to him before the interview began.
"That's their right," said Mehling. Stopping the local sale of OxyContin didn't stop the influx of pills on the street, said McLaughlin. "When crack hit it was like a bomb went off, but I'd never heard of prescriptions having this kind of effect," said McLaughlin, who has worked on drug cases since 1981. "It got so bad that people were hooked and started stealing from family and spouses to get money for the drug. Entire families were ripped apart." Those people just took Banaga's prescriptions to Akron, Toledo and Cleveland. The problem spread out, said McLaughlin.
Leaser now works at a Rite Aid in Lorain, but he said he has learned from the experience and only prescribes it to regular patients he knows. The Norwalk location still has a sign up behind the counter instructing pharmacists not to fill Banaga's prescriptions, said new pharmacist Greg Metcalf.
Mehling said he firmly believes there are other doctors in Lorain County now doing the same thing Banaga is accused of. The situation is a growing problem that law enforcement is just now realizing, he added.
"If you buy a schedule 2 narcotic like cocaine, you could get robbed or your car stolen in the process," said Mehling. "But you can get a schedule 2 OxyContin or Percocet prescription from a guy in a white coat, and any one of the 52 pharmacists in Lorain County will fill it. More and more we're seeing people go to a pharmacy instead of the street drugs because it's safer and a lot cheaper."
Banaga switched attorneys only three months after the initial indictment, and attorneys Michael Hennenberg and Thomas J. Dougan are now planning his defense. "The prosecuting attorney's office has been very open about providing discovery" said Hennenberg. "There is a great deal of complexity in this case."
If convicted, Banaga could receive more than 200 years in prison.
This is reprinted from the NFTP (National Foundation for the Treatment of Pain)
